ORIGINAL RESEARCH article
Front. Public Health
Sec. Health Economics
Volume 13 - 2025 | doi: 10.3389/fpubh.2025.1597550
This article is part of the Research TopicImmunization Economics: Balancing Costs, Outcomes, and Equity in Public HealthView all articles
Multinational cost-effectiveness analysis of pembrolizumab combined with chemotherapy as first-line treatment for advanced biliary tract cancer
Provisionally accepted
- The First Affiliated Hospital of Dali University, Dali, China
Select one of your emails
You have multiple emails registered with Frontiers:
Notify me on publication
Please enter your email address:
If you already have an account, please login
You don't have a Frontiers account ? You can register here
Background: Immunotherapy is a promising treatment for advanced biliary tract cancer. However, the cost-effectiveness of pembrolizumab combined with gemcitabine and cisplatin remains unclear across different healthcare systems. This study evaluates its international cost-effectiveness in four countries.A partitioned survival analysis model was developed using data from the KEYNOTE-966 trial to compare costs, quality-adjusted life years (QALYs), and incremental cost-effectiveness ratio (ICER) of pembrolizumab plus gemcitabine and cisplatin versus gemcitabine and cisplatin alone, from the healthcare system perspective of China, Japan, the United States, and Switzerland. Sensitivity and scenario analyses were used to identify key factors influencing the ICER.The base-case analysis showed that pembrolizumab plus gemcitabine and cisplatin provided additional quality-adjusted life year gains of 0.14 in China, Japan, and the United States, and 0.15 in Switzerland. The incremental cost-effectiveness ratios in all four countries exceeded their respective willingness-to-pay thresholds, indicating limited cost-effectiveness. Sensitivity analysis identified drug price and utility value of progression-free survival as key factors. In the United States, Japan, and Switzerland, an 80-95% reduction in pembrolizumab's price was necessary for cost-effectiveness, while in China, a reduction greater than 95% was required.Conclusions: Despite clinical benefits, pembrolizumab combined with chemotherapy for advanced biliary tract cancer is not cost-effective at current prices and willingness-to-pay thresholds. Adjusting drug pricing and healthcare policies is crucial for enhancing the global economic viability of this treatment strategy.
Keywords: Biliary tract cancer, Pembrolizumab, immune checkpoint inhibitors, multinational economic evaluation, cost-effectiveness analysis
Received: 21 Mar 2025; Accepted: 22 Jul 2025.
Copyright: © 2025 Xie, Liu, Xiao, Li, Qiu and Gu. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
* Correspondence: Yun Gu, The First Affiliated Hospital of Dali University, Dali, China
Disclaimer: All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article or claim that may be made by its manufacturer is not guaranteed or endorsed by the publisher.